Multifocal angiosarcoma of the gastrointestinal tract
2008; Thieme Medical Publishers (Germany); Volume: 40; Issue: S 02 Linguagem: Inglês
10.1055/s-2008-1077645
ISSN1438-8812
AutoresJoon Yau Leong, Miguel Ángel Dobón Rascón, Noopur Kaushik,
Tópico(s)Sarcoma Diagnosis and Treatment
ResumoA 60-year-old African-American woman presented with a history of several weeks of increasing shortness of breath and weakness. On examination, she was hemodynamically stable with heme-positive brown stool. Initial laboratory studies revealed a hemoglobin concentration of 4 g/dL. Upper endoscopy showed active oozing from a 2-cm ulcerated mass on the gastric incisura angularis ([Fig. 1]) and a 1-cm polypoid lesion in the second portion of the duodenum just proximal to the major papilla ([Fig. 2]). Biopsies demonstrated markedly atypical endothelial proliferation suggestive of a high-grade angiosarcoma versus exuberant granulation tissue adjacent to the ulcer ([Fig. 3]). Immunohistochemical stains were positive for CD31 ([Fig. 4]), vimentin, and pancytokeratin, consistent with epithelioid angiosarcoma (EAS). A positron emission tomography scan showed hypermetabolic foci in the stomach and in the region of the duodenum that were highly suggestive of malignancy; no other areas were identified. Due to continued gastrointestinal bleeding and the above findings, the patient underwent an exploratory laparotomy with distal gastrectomy, partial duodenectomy, and gastrojejunostomy. The final surgical pathological study confirmed the diagnosis of EAS.
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